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1. VACCINATION AGAINST
JAPANESE ENCEPHALITIS
Japanese Encephalitis has been in the news recently following
an outbreak in Malaysia, and this has brought attention to the important
role that vaccination may play in preventing and controlling further spread
of the disease. The Malaysian government promptly vaccinated more than
142 pig farm workers and took control measures to prevent vector transmission
by eliminating breeding sites. The importance of vaccination was also
demonstrated by Australia's recent inclusion of the vaccine in the Australian
Vaccination Schedule. The vaccine is a highly purified formalin inactivated
virus preparation derived from mouse brain and is widely used in Asia.
The vaccine is given in 3 doses on days, 0, 7, and 30 and protection can
be expected 10 days following the last dose. A shorter course of vaccination
(Day 0, 7, and 14) can be used, but protection and duration is less than
the normal schedule. A protective efficacy of 91% has been shown in children
receiving 2 doses. The vaccine should be considered for persons traveling
to endemic regions, and is not recommended for travelers under 1 year
of age. Immunization of pigs has also shown to have a significant effect
on preventing epidemics.

2. OVERVIEW OF INFECTIOUSDISEASE
INFORMATION FROM PROMED Here is our regular summary of
relevant AsiaPacific EID issues based on postings to the ProMED Electronic
Network, which is a prototype for a communications system to monitor emerging
infectious diseases globally as an initiative of the Federation of American
Scientists (FAS), cosponsored by WHO.

ASIA

INDONESIA (CENTRAL JAVA) DENGUE
A dengue fever epidemic in Demak regency, and greater Semarang area is
expected, following the deaths of six children from the same. 140 people
have been treated for the potentially deadly illness in the last four
weeks. Central Java authorities have begun fumigation with insecticides
to avert the epidemic, but admitted that their scope was limited by the
administration's budget.
[The Jakarta Post, 4/12/98]

THAILAND DENGUE VACCINE
Phase II trials of a dengue vaccine were commenced last month by Thai
researchers in Nakorn Pathom. The vaccine was developed at Mahidol University,
west of Bangkok, and is two to five years from commercial use. The Thai
project, initiated in 1976 by the regional office of the World Health
Organization, chose to make a live attenuated virus vaccine, an approach
used successfully against poliomyelitis, measles and mumps. In seeking
a strategic partner, the university signed a contract with the French
company Pasteur Merieux Connaught, giving it a 20year exclusive production
and marketing license worldwide. However, the contract also includes a
clause that says the vaccine would be affordable to children in developing
countries. The Mahidol researchers are now also working in collaboration
with the US Public Health Service on a ''secondgeneration'' dengue vaccine
based on molecular biology techniques.
[Philippine Daily Inquirer, 20/11/98]

VIETNAM (CENTRAL) UNIDENTIFIED DISEASE
A medical team is investigating an unidentified illness that has killed
five people and left 34 others sick in central Vietnam. The fatalities
occurred over the past week in Suoi Da village, and the main symptoms
were headcahe, chest pain, vomiting and coma. It is uncertain whether
the disease was related to water contaminated by flooding two weeks ago
that killed 14 people in the province.
[Nando Times, 5/12/98]

OCEANIA

AUSTRALIA JAPANESE ENCEPHALITIS VACCINATION
Japanese Encephalitis vaccine will be included on the Standard Australian
Vaccination Schedule, following a recommendation from the National Health
and Medical Research Council. The vaccine will be provided free to children
aged one year and older, living in the highrisk communities in the Torres
Strait and northern Cape York. The first cases of Japanese Encephalitis
were reported from Badu Island in the Torres Strait in 1995, two of which
were fatal. Following this outbreak, nearly 9,000 doses of inactivated
vaccine were administered to the residents of the central and northern
Torres Straits islands. A booster dose of JE vaccine was recently given
to residents in the islands about three years after the primary series,
in anticipation of the 1998/99 wet season (which has just begun). The
first mainland case was diagnosed in Queensland in March 1998. This is
the second case for this year, the other being an unvaccinated child from
Badu Island. Seropositivity among pigs in these regions suggest that JE
virus may have become epizootic, or perhaps even enzootic, in northern
Australia, and this poses a significant threat to Australia due to the
prevalence of suitable vector mosquitoes and vertebrate hosts throughout
most of the mainland.
[Australia's Commonwealth Department of Health and Aged Care Website]
[ProMed, 28/11/98]

PAPUA NEW GUINEA HIVTB EPIDEMIC
Papua New Guinea has been identified as a hot spot where coepidemics
of HIV/AIDS and TB have reached crisis levels. New estimates show HIV
incidence in PNG last year as two per 1000 adults, and seven per 1000
for tuberculosis. These proportions are still well below those in Cambodia,
which is now recording worse incidence rates than in East Africa. Papua
New Guinea has only one antiTB pilot project and while it may need the
help and expertise of Australia, the Australian Government aid agency,
AusAID is reluctant to commit to any new medical projects because of Papua
New Guinea Government's corruption and unreliability. AusAID continues
to support a Sexual Health Project, and has made a commitment to back
the current project next year with a nationwide project. In the past ten
years, a total of 1,346 people have been infected with HIV, and 133 out
of 490 victims of full blown AIDS have succumbed to the disease. 40% of
the 490 people affected with AIDS were between the ages of 15 and 25 years.
Of the country's total population of 4.5 million, more than 40% are in
this age group. Women tend to be the most vulnerable population with an
infection rate of 63%.
[The National, 27/11/98, 1/12/98, 2/12/98]

AMERICAS

CANADA (ALBERTA)E. COLI (EHEC) OUTBREAK IN DAY CARE CENTER
An outbreak of E. coli has affected at least 28 children in a day care
in Calgary. Public health officials were notified only eight days after
the first case was detected on Nov.10. Health authorities are in the process
of contacting and testing hundreds of children, their friends and families.
The day care has 70 children and 17 staff. Hospital emergency departments
have been alerted to watch for the disease. More cases are expected in
the coming days as the outbreak could have spread to other day care centers
or work sites where food is prepared. The origin of the outbreak is unknown.
The last comparable outbreak was in 1996 when 23 cases were confirmed
at a southwest Calgary day care. Prior to this outbreak, there have been
48 isolated cases of E. coli confirmed in Calgary this year.
[FSNET & The Calgary Herald, 25/11/98]

CANADA (BC) YERSINIA PSEUDOTUBERCULOSIS
An outbreak of Yersinia pseudotuberculosis in the Vancouver area has become
a cause for concern among epidemiologists in British Columbia. 40 cases,
(60% being children below 3 years of age) have been identified so far,
and the suspected source of contamination is food. Unpasteurised milk
and undercooked pork have known to be associated with this disease which
mimics appendicitis. The bacterium produces infection of the bowels, and
has no relation to tuberculosis as its name might suggest. Fever, vomiting,
diarrhea, and lower abdominal pain are common symptoms. The bacterium
is found in farm animals, particularly pigs, as well as pets and wild
animals. Scientists will begin testing food samples and interviewing people
this week but it may take weeks to track the source. Being an uncommon
disease, scientists lack enough expertise in this organism, especially
since the average number of cases that have been reported each year are
only five.
[GPHIN, 1/12/98]

MEXICO  HEMORRHAGIC CONJUNCTIVITIS
An outbreak of haemorrhagic conjunctivitis has affected 11,465 people
this year, 99% of cases being reported after June. Last year only 816
cases of haemorrhagic conjunctivitis were recorded, reflecting on a sharp
increase this year. The disease is characterised by swelling and bleeding
in the eyes, but the causative agent has not been reported as yet.
[Reforma, 2/12/98]

USA CONTINUING TRANSMISSION OF TB AFTER DOTS
Continuing transmission of TB in the US even after implementation of DOTS
was demonstrated in a prospective cohort study done in Baltimore, Maryland.
64 patients infected with clustered strains had no epidemiological links
with each other, but shared the same risk factors as 20 other patients
with the same clustered strains and were found to be geographically clustered
on the periphery of the areas where the latter lived. This brings to attention
the need to target neighbourhoods where transmission is occurring for
active case finding, upperroom germicidal irradiation, screening, and
preventive treatment.
[Eurosurveillance Weekly, Vol. 2, Issue 48, 26/11/98]

OTHER

PAHO REPORT ON EPIDEMIOLOGICAL SITUATION IN CENTRAL AMERICA
Epidemics of cholera, leptospirosis, and haemorrhagic dengue have been
reported in Guatemala, Nicaragua, and Honduras, following Hurricane Mitch.
The health authorities in these countries are taking great effort to improve
epidemiological surveillance, that in turn has increased epidemiological
reporting. The risk of leptospirosis is greatest in Nicaragua, and the
Ministry of Health has responded by strengthening medical services, carrying
out environmental health campaigns, using rodenticides, and identifying
potential animal hosts. The cumulative number of cases of leptospirosis
for the postMitch period is 523, and 7 deaths with a casefatality rate
of 1.3%. Guatemala has recorded 1,362 suspected cases of cholera in the
first three weeks following Hurricane Mitch. 17 deaths and a casefatality
rate of 1.25% were reported. 1,165 suspected cases of classic dengue,
49 confirmed cases of haemorrhagic dengue, and 4 deaths have been reported
in Honduras. El Salvador and Belize have reported outbreaks of cholera
that are under control now. PAHO continues to recommend intensive epidemiological
surveillance and vector activities, both in populations exposed to the
open and those in shelters. More details on the epidemiological situation
in Central America following Hurricane Mitch can be found at http://www.paho.org/english/ped/pedep30.htm

OUTBREAK OF MDRTB IN COLUMBIA
Investigations of an outbreak of MDRTB among 24 patients in Buenaventura,
Colombia, in October 1997, revealed an evident lack of coordination and
effective communication between personnel at local health posts. A wide
gap between theoretical knowledge and practice in case finding, surveillance,
management, and treatment of patients was found. Patients were responsible
for sputum collection and transport of specimens. An analysis of the clinical
management of the patients with resistance showed that only two thirds
of the patients had been prescribed DOTS correctly, and none had been
given the correct treatment regime after a failing DOTS treatment. The
median elapsed time since first TB diagnosis was 4 years, and 100% of
patients had at least a 2year history of TB. 92% had TB medications improperly
added and subtracted from their treatment regimes; only 72% of individuals
who had abandoned treatment for 1 month or more had a smear done upon
their return treatment; and 79% of the patients had abandoned treatment
at least one time. Findings from this investigation have led to improvements
in TB control efforts in Buenaventura in the form of structural changes,
training for physicians and healthcare workers, use of DOT for both MDRTB
and other patients, and new treatment regimes based on drug susceptibility
testing results. Other recommendations that were added to the report focused
on laboratory capabilities, infection control programs, and health education.
[CDC TB Notes Newsletter, No.3, 1998]

HIV PREVENTION IN THAILAND
Perinatal HIV transmission will be receiving more attention from the Thai
government following Princess Soamsawali's recommendations. Better followup
of HIVinfected mothers and their children will be facilitated by extension
of the ministry's free infant formula programme to children beyond one
year of age. While both the ministry, and the Thai Red Cross Society have
allocated more money and antiretroviral drugs to HIVpositive women,
the society provides therapy for a longer period (from 14㪺 weeks of
pregnancy until delivery and intravenously to newborns)than the ministry.
Thailand has experienced a dramatic reduction in unsafe sex practices
during the past 6ף years following campaign efforts by the government.
There is a potential for a change in behavior as the HIV/AIDS epidemic
may not be perceived as a threat anymore. The economic crisis may also
increase the number of sex workers in the country, some of whom may be
coming from across the border in Vietnam and Cambodia. Other concerns
have to do with targeting married women who have been infected by their
husbands, and the long term consequences for HIVpositive women who are
currently enrolled in clinical trials once they have been taken off AZT.
[Seaaids, 25/11/98, 27/1//98]

3. UPDATES FROM PREVIOUS BULLETINS

CHINA  CULTURAL DIFFICULTY IN VOLUNTARY BLOOD DONATION
Cultural beliefs about blood donation may make it harder for China to
implement voluntary blood donation while attempting to eliminate illegal
blood trade at the same time. Blood is equated with health in China, and
blood donation is considered disrespectful to ancestors and parents. The
Chinese Government has banned the sale of blood as of October 1 in an
effort to reduce the spread of bloodborne diseases, especially HIV.
[U.S. News and World Report, 09/11/98]

JAPAN (YAMAGUCHI)E. COLI, NURSING HOME
The outbreak of E. coli in Yamaguchi Prefecture has affected 36 people
so far, with 4 deaths, and one person in a critically ill condition. The
source of contamination was found to be a daikontuna salad served in
the nursing home which was consumed by 52 people, giving an attack rate
of 69.2%. The salad contained daikon, lettuce, wakame, tuna, and nonoil
salad dressing. The Health Department could not identify which food item
was actually contaminated with E. coli O157:H7.
[Various Japanese news media, translated, 29/1//98]

MALAYSIA JAPANESE ENCEPHALITIS
The outbreak of Japanese Encephalitis in Perak has been brought under
control following efforts by State health officials to eliminate breeding
grounds of the Culex mosquito, the carrier of the virus. No new cases
have been reported in the last few weeks, but health officials continue
to monitor the situation. The Institute for Medical Research has confirmed
the cause of the illnesses as Japanese Encephalitis virus.
[New Straits Times, 25/11/98]

GLOBAL CONGRESS ON LUNG HEALTH
The first day of the Global Congress on Lung Health was devoted to DOTS,
TB/HIV, and MDRTB. Global targets for TB control would be reached only
in 2025 due to the current slow expansion of DOTS strategy (2% per year),
and thus the value of DOTS was emphasized with reference to cure rates
of 78% in areas where it was used. Duration, and advances in treatment
for patients coinfected with TB and HIV were discussed, and a clear message
was that, standard duration of short course chemotherapy was adequate
for TB/HIV patients. Preventive therapy was addressed in great detail,
following which a symposium on rifapentine, a new drug, was held, and
treatment outcomes were discussed. Failure rates with this drug are considerably
lower than with rifampicin. The third day of the conference included a
report on sequencing of the M. tuberculosis genome that will allow researchers
to identify specific genes responsible for latency, virulence, resistance,
and immunity. New diagnostic tools, drugs and vaccines were also part
of the report. The human rights aspects of TB were also addressed in a
symposium on patient organisations. Detailed reports on particular topics
can be accessed at http://www.southasia.com/ngotb/index.htm
[tbnet]

4.
NOTICES

The WHO Western Pacific Office (WPRO) Web site can now be visited at:
http://www.who.org.ph/ STD, HIV and AIDS information can be accessed directly
at http://www.who.org.ph/technical/programme/std.htm

ANTIBIOGRAM DATA ONLINE: WEBSITE ANNOUNCEMENT
Antibiotic susceptibility reports from volunteer laboratories in the U.S.,
Australia, South America, and Israel, are available on the ID Links web
site. Standardized antibiograms show local and regional trends in antimicrobial
resistance which would be useful to infectious disease specialists, clinical
microbiologists, pharmacists and infection control practitioners. More
antibiograms are welcomed to improve this site which can be accessed at
http://www.idlinks.com tb.net

CONFERENCE ON HUMAN RIGHTS AND TB
"People at Risk, Rights at Risk" is the title of the third tb.net conference
and will focus on TB and Human Rights. The conference will be held in
Kathmandu, Nepal from 24㪲 February 1999. The conference will have three
groups of subjects; 1. Presentations and discussions on TB in groups of
people often denied their basic rights; for example refugees, prisoners,
and migrants 2. Debates on aspects of TB control that have been accused
of denying basic human rights, such as; DOT, HIV testing, unavailability
of treatment for MDRTB 3. Workshops to empower organisations and individuals
to take effective action to promote human rights; advocacy, social mobilization,
andresearch The conference is open to all, and registration fee is $50.
For more information, please contact Ms Upasana Shrestha, tb.net '99 conference
manager at: Address: UMN PO Box 126, Kathmandu, Nepal Tel: 00977 1 613048
Fax: 00977 1 225559 Email: tb@mos.com.np

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